Table Of ContentJanuary 24, 1996
The Honorable Steve Gaw
Speaker
Missouri House of Representatives
House Post Office
State Capitol
Jefferson City, MO 65101
The Honorable James Mathewson
President Pro Tern ·
Missouri Senate
Senate Post Dffice
State Capitol
Jefferson City, MO 65101
Re: SCR #17
Dear Representative Gaw and Senator Mathewson:
Pursuant to SCR #17, your joint committee appointed to study
the transfer of the Missouri Rehabilitation Center at Mt. Vernon,
Missouri, from the Department of Health to the University of
Missouri does hereby submit the attached report.
During the First Regular Session of 88th General Assembly,
legislation was introduced proposing the transfer of the Missouri
Rehabilitation Center located at Mt. Vernon, Missouri, from the
Department of Health to the University of Missouri. On April 25,
1995, the House of Representatives adopted SCR #17 which
established an interim committee to study the transfer. Your
interim committee was appointed shortly after the session
concluded. On September 21, 1995, the Board of Curators of the
University of Missouri adopted a resolution approving the
transfer. That resolution is enclosed and identified as
Attachment 1. The c·ommi ttee held a public hearing in Mt. Vernon
on November 6, 1995.
on January 17, 1996, Governor Carnahan, in his address to
the General Assembly, expressed continued support for the
transfer and made certain budget recommendations which, if
approved by the General Assembly, would meet the requirements of
the University of Missouri as set forth in Attachment 1.
In summary, your committee appointed to study this matter
has concluded that it is in the best interests of the State of
Missouri for the transfer to proceed. The legislation to
accomplish this purpose has been introduced by Senator Morris
Westfall as SB 540. The University of Missouri has agreed to
operate the Missouri Rehabilitation Center at Mt. Vernon as a
part of the University Hospitals and Clinics. It is proposed
that the transfer would be accomplished in the same manner that
Ellis Fischel State Cancer Center was transferred to the
University from the Department of Health in 1990. The State
would continue to invest the same amount of general revenue that
it has in the past for the operation of MRC. Failure to approve
the transfer will mean the State will need to increase general
revenue support for MRC because other sources of revenue are
expected to decline unless the Center can compete in a managed
care environment.
The transfer would mean that the important state health
mandates of continued operation of a head injury center and a
tuberculosis laboratory will continue. All other options
considered would have meant a greater expenditure of state
general revenue to maintain these services. Further, the
transfer will have a positive impact on the University of
Missouri Hospitals and Clinics as they do not have a long-term
rehabilitation facility to support training at the University of
Missouri-Columbia School of Medicine.
If the Missouri Rehabilitation Center is not transferred to
the University of Missouri or is closed, the State will need to
dramatically increase the amount of state general revenue that is
used to support the services provided by the Center. Additional
funds that are now received to meet costs above the current
appropriation are derived principally from federal Medicare and
Medicaid sources and will be in jeopardy with upcoming changes in
both of these programs. The University of Missouri Hospitals and
Clinics feels certain that they can increase revenues from
traditional health insurance opportunities and in the area of
insurance managed care.
You will also find enclosed Attachment 2 entitled "Proposal
to Merge the Missouri Rehabilitation Center with the University
of Missouri Hospital and Clinics" where the transfer and its
program offerings are more fully discussed.
C Z ~
Representative Richard Franklin
Representative William Marshall
Attachments
ATTACHMENT 1
Recommended Action - Transfer of the Missouri Rehabilitation Center in
Mount Vernon, Missouri - UM
It was recommended by Chancellor Kiesler and Vice President McGill,
endorsed by President Russell, moved by Curator Hall, seconded by Curator
Gillespie and carried, that the following action be approved:
a. that President Russell be authorized to advise the Governor and
General Assembly of the willingness of the University of Missouri
to accept the transfer of the Missouri Rehabilitation Center (MRC)
in Mount Vernon, Missouri, subject to the following conditions:
i. sufficient annual general revenue appropriations be made to
the University over and above earned patient revenues at MRC
to support the operation of MRC without there being a need
to transfer funds from other University operations;
ii. sufficient one-time capital appropriations be made to the
University to update the MRC facilities to University
standards;
iii. sufficient one-time appropriations be made to the University
to cover all accrued personnel benefit liabilities;
iv. appropriations be made to install and operate a two-way
telemedicine link between MRC and the Columbia Health
Sciences Center;
v . the University retain the ability to adjust the patient care
programs at MRC to best meet the State's responsibilities
within the capabilities of the University to provide those
services and to enhance the facility's role in the education
and research missions of the University;
vi. the University has the authority to adjust MRC staffing
lev~ls and operations.
b. that if the Governor and General Assembly wish to have MRC
transferred to the University, President Russell be authorized to
seek the necessary appropriations, agreements as to patient care
reimbursements, and enabling legislation.
ATTACHMENT 2
PROPOSAL TO MERGE MISSOURI REHABILITATION CENTER
WITH UNIVERSITY OF MISSOURI HOSPITAL
AND CLINICS
OVERVIEW
Missouri Rehabilitation Center (MRC), located in Lawrence County in Southwest Missouri, is
currently operated by the Missouri Department of Health as a provider of tuberculosis services,
traumatic brain injury care/rehabilitation, pulmonary rehabilitation, comprehensive rehabilitation,
medical acute care and terminal care. The facility is mandated by state statute to provide the
tuberculosis services and _traumatic brain injury services. It is primarily because of the provision of
the programs mandated by statute that the Department of Health (DOH) has felt compelled to
continue to operate the facility. DOH actually sees its role as evolving into one of assuring provision
of services to Missouri citizens, assessing quality of service, and assessing outcomes rather than
direct provision of care.
By merging Missouri Rehabilitation Center with the University of Missouri Hospitals and Clinics
the citizens of this state are benefitted in that Department of Health can focus on activities related
to quality of care while University of Missouri Hospitals and Clinics (UHC) can use its experience
and abilities that add to its attractiveness as a full line provider of health care services. State
government benefits in that there would be more effective economies of scale for the provision of
the statutorily mandated services.
Another way in which it is anticipated that the state potentially benefits is that, with increased
penetration of managed care programs in the group health insurance market, there will ·i:,e an
increased number of individuals with disabilities who are dependent on the public sector for their
care due to either a limitation or the scope or type of services offered by such organizations in an
effort to control their cost. Although state government will attempt to limit such "dumping", it is
likely that the incentives to the managed care org~zation to limit its exposure in an area that can
be critically expensive will override the government's ability to provide safeguards. The choices are
for the state either to attempt to control the managed care organizations by mandating benefits or to
assist in the development of a cost efficient system which would serve as a resource for all citizens
in the state, including those enrolled in managed care plans. If the system is built on cost effective
pr:inciples which spread and control the risk, such as capitation, case management, economies of
scale, and evaluation of efficacy of treatment, it is possible that such an operation could, in fact, save
money in the end.
Education of the next generation of Missouri's health providers in the area of chronic care becomes
more important as society attempts to grapple with the issues of care that arise as a result of people
living longer and in a more violent society. Currently, the University of Missouri-Columbia
provides the largest percentage of primary care physicians in the State. By associating a chronic care
program with University, opportunity for this critical piece of learning is assured.
Maintenance of critical jobs in Lawrence County is an important consideration as well. MRC is the
largest employer within the county, with some 470 individuals employed by the facility. Since the
southwestern part of the state is the fastest growing area of the state, the merger of MRC and UHC
would virtually guarantee that the majority of jobs associated with institution would be preserved.
MISSOURI REHABILITATION CENTER PROPERTY
Missouri Rehabilitation Facility consists of a main campus and two farms. There are six
interconnected buildings on the main campus which is located in Mt. Vernon on approximately
182.5 acres. The buildings range from 86 to 26 years and contain approximately 280,000 square
feet.
One farm is located two miles north of Mt. Vernon and contains 145 acres with a stone house,
garage, and barn. The second farm is one mile west of Mt. Vernon and has a house and garage.
SERVICES OFFERED BY MRC
TUBERCULOSIS
The Missouri Rehabilitation Center houses the TB Laboratory for the State of Missouri. In addition
to serving as a state TB Laboratory, it has become a national resource for the diagnosis of TB.
The lab is staffed with well-trained mycobacteriologists who have many years of accumulated
expertise and experience. The field of Mycobacteriology (TB work) is so specialized that general
lab techs, even microbiologists, cannot transfer into TB work and expect to successfully carry out
the operations.
The staff has 127 cumulative years in TB work, plus extensive skills in instrumental chemistry,
computer programming and system maintenance, management, public health microbiology, and
customer service. Given the crisis being experienced in tuberculosis control at the present, it would
be a miscarriage of public health practice to dissolve the present TB laboratory and attempt to
reconstruct it elsewhere.
Although it is possible to contract out the tuberculosis services, other states that have closed their
labs have experienced dismal results. The states lost all control over patient/specimen tracking and
epidemiological data. There were also serious issues of quality of work, since commercial labs could
not guarantee that microbiologists with experience and specific training in tuberculosis actually did
the work. Pennsylvania tried contracting in the early 1980s, a trial which lasted one year with
absolute failure. They experienced serious problems then trying to re-open their state lab after
closing and losing their personnel.
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Information handling and data storage potentially present major problems to the TB control program
under a commercial lab scenario. Commercial laboratories normally do not maintain patient records
very long and they usually do not maintain them in a usable database. An advantage of our state
system is that we maintain records and can track specimen and patients for years ( decades if
necessary). Our data is easily retrievable.
CLINICAL PROGRAMS
Currently the Missouri Rehabilitation Center provides patient care programs in the area of traumatic
brain injury, comprehensive rehabilitation, pulmonary/ventilator rehabilitation, tuberculosis
treatment, terminal care, acute care and outpatient services. Generally these programs are what
would be terms sub-acute. Such programs provide care for the patient who is too ill to go home but
progressing too slowly to be maintained in an acute care hospital or whose rehabilitation needs are
too extensive to handle as an outpatient.
Sub-acute care programs are designed to provide coordinated, comprehensive services that increase
the functional abilities of the recipients. Sub-acute programs improve the functioning of the
recipients, using lower cost services. Programs that go beyond the nursing and physical therapy
services offered by long term care facilities known as skilled nursing facilities, such as the
rehabilitation programs offered by MRC, provide the best hope of finding a level of functioning for
victims of catastrophic trauma that minimizes the drain on society and in the long run decreases
public expense in caring for them.
The Respiratory/Pulmonary Program at MRC is currently based upon the team approach in which
the therapies that are involved in the physical medicine and Rehabilitation program also parti<:.ipate
in the total care of the pulmonary patient. This approach enhances the rate of successful outcomes
in one of the major functions of this clinical service: the weaning of individuals from ventilators.
Occupational Therapy, Physical Therapy, Psychology and Speech Pathology collaborate with the
physicians in the development of a clinic plan of care. In addition, aggressive Respiratory Therapy
Department coordinates the various elements of that program and also supervises a very successful
outpatient Cardiopulmonary Rehabilitation Program.
The Traumatic Head Injury/Physical Rehabilitation Program at MRC is currently based upon an
intensive multi-disciplinary team approach. It is an extension of the acute hospital and acute
rehabilitation phase of treatment. It provides a continuum of care of ma'<:imize independence and
functionality and addresses the community integration needs of the individual. A variety of services
are currently offered. These include physical medicine and rehabilitation, neuro-rehabilitation,
neuropsychology, behavioral dysfunction, occupational therapy, physical therapy, speech and
language therapy, recreational therapy, education and substance abuse counseling. Vocational
rehabilitation which includes assistive technology evaluations and augmentative communication
assistance is a service to both the inpatient and outpatient populations.
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MISSION OF FACILITY FOLLO\VING MERGER
The mission of the facility following the merger would read as follows:
The Missouri Rehabilitation Center is a public institution sponsored by the University of Missouri
Health Sciences Center. We are committed to providing compassionate rehabilitation services,
treatment for pulmonary conditions and related research and e~ucation for the citizens of Missouri.
As a public health facility, we respect and value the dignity of each person, regardless of sex, race,
age or physical handicap. Through the provision of direct patient care, we seek to relieve suffering,
address its causes and promote good health and well being.
Our commitment to care extends to employees, volunteers and medical staff as well as patients.
Therefore, all groups shall be provided with a climate and opportunity for service to the institution.
Through cooperative efforts, :MRC provides quality, compassionate healthcare services in a pleasant
work environment.
MRC recognizes the historical role that it has played in the development of the State of Missouri.
In order that we may continue to meet state needs, we reach out to communities and facilities and
offer our assistance. As a University health institution, we strive to provide sophisticated
technologies to the citizens of Missouri. We stand ready to serve others as their needs dictate and
our capabilities allow.
MARKET DEMAND FOR MRC SERVICES
In an attempt to gauge possible future demand for services at the Missouri Rehabilitation Cehter,
incident rates for the major diagnostic conditions were examined. The incident of tuberculosis in
Missouri during calendar year 1993 was 4.9 cases per 100,000 population. The greatest proportion
of these patients reside in rural areas, where follow-up on treatment compliance is often most
difficult. Missouri data on the incidence of ventilator dependency using ICD9 codes suggests the
incident rate is 8.26 per 100,000 population, or 426 cases for calendar year 1993. Department of
Health data on the incidence of health injury in Missouri in 1992 indicates an incidence of 102 cases
per 100,000 population. This translates into an occurrence rate of approximately 5,000 patients per
year, of which approximately 4,300 were hospitalized. Spinal cord injury average 63 cases per
million. The admission rate was 51 per million, or 265 admissions. Death from spinal cord injury
occurred at the rate of 16 per million.
REQUIRED IMPROVEMENTS
In order to make the Missouri Rehabilitation Center a competitive health facility refurbishing will
be necessary. Two types of improvement are needed: Cosmetic changes to make the facility appear
more contemporary; and more substantial capital improvement in order to realize accessibility and
modernize the buildings.
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Cosmetic improvements will be required. This amount will cover the cost of new wall coverings,
pictures and painting throughout the patient care units and lobby areas. Interior and exterior signage
is also included in this amount.
Other more sizable capital improvement projects include: remodeling of the new dormitory for
handicap accessibility, air conditioning, sprinkler/fire alarms, new windows, waterproofing and
upgraded electrical services.
With these improvements, MRC will be a comprehensive, modem rehabilitation facility capable of
providing coordinated rehabilitation services in a pleasant and functional environment.
MRC EMPLOYEES
MRC is fortunate to have a highly skilled, highly trained, and highly caring staff of health care
workers that have continued to provide high quality health care to our patients over the years. They
are more than willing to meet the day-to-day challenges involved in the special needs of MRC's
patients. While their expertise has been and is valuable to the institution, their ability to find other
employment in the health care field in this geographic area is severely handicapped because of the
downsizing and restructuring that is taking place in health care facilities in the immediate
demographic area, which 1ncludes both Springfield and Joplin.
As Mt. Vernon's and Lawrence County's largest employer, MRC has a significant impact on the local
economy with an annual payroll of over $10.5 million, excluding fringe benefits, that represents $63
million dollars of revenue if you assume that one dollar turns over six times (s even times by" some
estimates) before it leaves the community. If MRC were to close, local businesses as well ~ the
school systems would feel a significant economic impact, since approximately 75% of the employees
live in Mt. Vernon or Lawrence County.
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FINANCES
The University of Missouri has agreed to assume ownership ofMRC at the current level of general
revenue funding. The fiscal year of 1996 general revenue appropriations for NIRC was $9.3 million
It is anticipated that this amount will increase consistent with the state pay plan for fiscal year 1997.
ONE-TIME COSTS FOR TRANSFER OF MRC
Deferred Maintenance 2,509,522
Telecommunication Linkage 800.000
Sub-total Physical Adaptations 3,309,522
Accrued Vacation/Comp/Holidays 669,812
MOSERS Retirement 188.772
Sub-total Employee Benefits 858,584
Total One-Time 4,168,106
Less Earnings Fund Balance -1,072,866
One-time net of Balance 3,095,240
Recommended appropriation to account for
variances in final employee benefit costs and
earnings fund balance. 3,350,000
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SUMMARY
It is estimated that it would take two years to modify existing programs and refocus Missouri
Rehabilitation Center into an appropriate market niche. By introducing the University's educational
programs to MRC, an opportunity for additional revenue through direct and indirect Medicare
Education Cost Provisions is provided. During these first two years some programs would be
discontinued and phased out while others would be further developed and enhanced to create Centers
of Excellence. Potentially a program could be developed which could be marketed throughout
Missouri to managed care systems as a stop loss provision for catastrophic illness and injury
occurring to their insureds.
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